Time based coding - 2011 revision changes

.. Another major change has happened with "time based" coding for CPT. The introduction section of CPT now includes new guidelines for time measurement for those codes with a time basis for code selection. (i.e. critical care, standby, E&M etc)

• Time is the face-to-face time with the patient
  
  
• “Interpretation and report” in the code description is not intended to indicate that report writing is part of the reported time.
  
  
• A unit of time is attained when the mid-point is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and sixty minutes). A second hour is attained when a total of 91 minutes have elapsed.
  
  
• For codes ranked in sequential typical times, when the actual time for the service falls between two typical times, the code with a typical time closest to the actual time is reported. (i.e. E&M when 38 minutes were spent, and the closest time is 35 minutes)
  
  
• When another service (such as a procedure) is performed concurrently with a time based service, the time associated with the concurrent service should not be included in the time used for reporting the time based service.
  
  
• Times for services measured in units other than days are considered continuous times even if the service extends into another calendar date.
  

I hope this is helpful for you. Please e-mail me if you have further questions at webbservices.lori@gmail.com

HAPPY CODING!

CPT corrections, My coding handbook & the New HCPCS Wellness codes for Medicare

Whew....... Now that the holidays are over, we are in the midst of the Mid-January slump… so we really need to re-charge our “coding batteries” and get back to it!

I also want to extend a warm welcome to my new blog-site readers, and a big THANK YOU to my continuing supporters. You make it all worth it! I'm a firm believer is sharing the information - continue your education!

This week I have included the link for the CPT errata for the corrections to CPT 2011 that didn’t get put into the printed volumes. (see below)

http://www.ama-assn.org/ama1/pub/upload/mm/362/cpt-2011-corrections.pdf

This is a PDF file, that you can download and keep on your computer, or print out and file into your CPT books. Be sure to review this info carefully.... you never know when it might be applicable to you or your practice.

This week I've had inquiries regarding where to find information on a "coding handbook". It was so coincidental, as I was able to send them a copy of my “coding manager handbook”… I have it available on PDF file. If you are interested, please send me an e-mail. I’m happy to share.

I originally wrote this for a national publishing company, but was unable for it to go to press due to the complex economic downturn. So if you’re interested, please let me know. It really is a “basic handbook” for all you’ll need to know to work in or manage a coding department.

Anyway… The hot-topic for today is the new Medicare wellness codes for 2011

If you want the detailed information on this, please check out the info direct from the CMS website(s). http://www.cms.gov/MLNMattersArticles/downloads/MM7079.pdf and site http://www.cms.gov/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf

The “Welcome to Medicare” exam commonly referred to as the IPPE (code G0402-G0405) is still in effect, and applicable only for the first 12 calendar months of a beneficiary's eligibility and should be coded as

IPPE HCPCS CODES	BILLING CODE DESCRIPTORS
G0402	Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment
G0403	Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report
G0404	Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination
G0405	Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

Below are the new 2011 HCPCS codes for a “wellness” type of exam.

G0438 - Annual wellness visit, includes a personalized prevention plan of service (PPPS), first visit, (Short descriptor – Annual wellness first)

This will need to be coded the FIRST time the patient has this performed

Can only be billed ONCE in a beneficiary’s lifetime

This code G0438 will be denied if billed within 12 months of a beneficiary’s eligibility to Medicare, as the beneficiary would be eligible for the IPPE “welcome to Medicare exam”. Please see criteria above for the IPPE exam.

G0439 - Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit, (Short descriptor – Annual wellness subseq) will be implemented January 1, 2011, through the Medicare Physician Fee Schedule Database (MPFSDB) and Integrated Outpatient Code Editor (IOCE).

This will need to be coded SUBSEQUENT yearly if the G0438 was billed or coded previously.

This is not to be billed more than 1 time within a previous 12 months

This code G0439 will be denied if billed within 12 months of a beneficiary’s eligibility to Medicare, as the beneficiary would be eligible for the IPPE “welcome to Medicare exam”.

The reimbursement for these procedures equate closely to the reimbursement for a 99214 level office E&M. I encourage you to carefully review the criteria, and make sure that you are documenting and coding appropriately for these visits. In addition, if you have performed a “separately identifiable” E&M service, this can be billed. The caveat to this is that the separate E&M service was/is medically necessary, and is well supported.

Till next time……….. HAPPY CODING!!